How do you tailor Group Medical Insurance to the diverse needs of your employees?

As an HR manager or business owner, offering group medical insurance to your employees is an excellent way to ensure financial protection and secure their health. Not only does it protect them from incurring out-of-pocket expenses for covered medical risks, but it also allows them to live their lives with confidence and peace of mind.

However, as every employee is different, it is also essential to tailor medical insurance policies to the diverse needs of your employees and the organisations. This is where a group insurance plan enables organisations to provide tailor-made and customised group medical insurance for family of the employees.

What is group medical insurance?

It is a type of health insurance specially developed to provide health insurance to several individuals in a single unified policy. Under this scheme, individuals and their families with common interests can be combined under a single policy. In this case, all employees of an organisation can be given health insurance coverage under a single policy, enabling companies to provide standardised coverage and offering convenience and cost-effectiveness.

Who is eligible for the employee group insurance scheme?

Companies with at least seven employees are eligible for employee group insurance scheme. Although some insurers might have their benchmarks and requirements for the minimum number of employees an organisation needs to be eligible for this insurance, companies with at least seven employees can secure their health with medical insurance.

How do you tailor a group medical insurance policy?

As an employer or HR manager, there are several factors to consider when choosing an insurance policy. Not only is it essential to consider the needs of the employees, but it is also important to consider the organisation's finances when planning a budget, industry requirements for minimum coverage, and several other factors.

Here are some of the critical factors to consider when choosing and customising a group medical insurance policy based on the organisation and employees’ needs.

• Consider the needs of your employees

  It is essential to consider the specific needs of your employees before buying a group insurance plan, as they are the primary beneficiaries, and the policy is to ensure their well-being.

• Pre-existing disease coverage

  Group insurance plans need to have coverage for pre-existing medical conditions to protect employees from out-of-pocket expenses.

• No pre-policy medical checkup

  Many group health coverage plans offer policies with no pre-policy medical check-ups, making the process more convenient.

• Coverage for dependents and immediate family where required

  Under group policies, companies can provide group mediclaim insurance policy for employees and their loved ones in a single policy.

• Cost-effective premiums

  The group plans charge a lower premium, so consider getting a policy with more substantial coverage.

• Waiting period

  A waiting period is the amount of time an insured individual needs to have the plan before being able to claim settlement. So, organisations should consider providing health insurance plans with minimal waiting periods.

• Hassle-free cashless claims and claim reimbursement process

  One more essential factor to consider is whether the insurer offers casOne of the other factors to assess is the ease of claiming settlement through cashless claims or reimbursement.

• Pan-India availability

  The policy must be applicable pan-India to avoid any financial loss when travelling out of state for business or leisure.

• Access to a good mix of network hospitals throughout the country

  Another vital factor to consider when purchasing a policy is the network hospitals, as those are healthcare facilities that offer instant cashless claims. A good mix of primary, secondary and tertiary care hospitals is highly beneficial.

Read Also: An Employer's Guide to Managing Group Medical Insurance Regulations

Where to buy a group medical insurance policy?

Organisations and decision-makers can buy medical insurance from various channels, such as directly from leading health insurance providers like Niva Bupa, through reliable insurance brokers, or from banks. Once the organisation's needs and budget are set, decision-makers can approach an insurance provider or broker for a specially designed plan customised for the company's unique needs and requirements.

Conclusion

Whether it is the customisability, cost-effectiveness, or convenience, an employee group insurance scheme is the best option for organisations looking to provide health insurance to their employees. By considering the above factors, organisations can tailor a group medical insurance policy based on their needs, allowing them to comply with the industry requirements, providing the necessary coverage for employees, and considering the budget and finances of the organisation.

FAQ

1. Do insurance brokers help with health insurance customisation?

Yes, absolutely. Insurance brokers play a vital role in helping companies craft tailored health insurance plans that suit the specific needs of their workforce. In the context of group health insurance India, brokers act as intermediaries who assess your team’s demographics, risks, and preferences to create a well-balanced coverage structure.

Their expertise ensures that your group medical insurance for employees isn’t just a one-size-fits-all product. Instead, it’s strategically designed to offer relevant benefits, optional add-ons, and cost-efficient premium management. Brokers also assist with negotiations, claims support, and ongoing policy adjustments—making the whole experience more streamlined.

2. Can employees choose their own add-ons in a group medical health insurance?

In many cases, yes. While the base plan of group medical insurance for employees is typically standardised, several insurers in group health insurance India offer flexibility through voluntary add-ons. This means employees can enhance their coverage by adding maternity benefits, critical illness cover, personal accident insurance, or top-ups—based on their individual or family needs.

This approach empowers employees with a semi-tailored health insurance experience, where they can customise beyond the default offering while still enjoying the core benefits of group cover.

3. Should group medical insurance cover family members too?

Ideally, yes. A comprehensive group medical insurance for employees should extend to their immediate family—spouse, children, and sometimes parents. Including dependents boosts employee morale, improves retention, and positions your company as a caring employer.

In the Indian context, where health expenses can burden entire families, many organisations are upgrading their group health insurance India policies to include family coverage. With the availability of tailored health insurance options, employers can choose to bear the cost or allow employees to contribute towards their dependents’ premiums through payroll deductions.

4. Is it possible to adjust benefits of group health insurance mid-year?

Yes, but with conditions. While traditional policies are renewed annually, some insurers under group health insurance India allow mid-year adjustments in response to life events (e.g., marriage, childbirth) or significant workforce changes.

Whether it’s increasing the sum insured, modifying add-ons, or including more family members, insurers may accommodate these changes—especially in tailored health insurance plans. Working with a broker or advisor makes this process smoother, ensuring your group medical insurance for employees evolves as your workforce does.